SLEEP IN THE ELDERLY: HEALTHY SLEEP FOR HEALTHY AGEING
Keywords:
sleep, heathy ageing, elderly, sleep quality, cardiovascular diseases, neurodegenerative disorders, Alzheimer’s disease, Parkinson’s disease, longevity
Abstract
Sleep is a vital physiological process in which humans spend almost one third of their lives. Contemporary lifestyles, shift work, social jet lag and environmental blue light pollution significantly compromise sleep quality in all age groups, especially in working adults and the elderly. Poor sleep quality has been demonstrated to be a risk factor for a number of diseases, from cardiovascular to neurological including malignancies.
Aging has been identified to be connected with poor sleep quality, making the elderly people more vulnerable for development of a number of somatic and mental disorders. Low sleep quality in the elderly accelerates aging and increases a risk of development of aging-related pathologies. There is increased societal attempts to sustain well-being and preserve health in aged population with the concept of healthy aging being widely promoted and accepted.
Healthy sleep has been recognized as one of the pillows of healthy ageing, especially in all policies related to Decade of Healy Aging. One of the major sleep –related issues in the elderly is difficulty to distinguish physiological effects of aging on sleep pattern from those sleep disruptions caused by primary sleep disorders, other diseases or medications. Poor sleep quality and impaired sleep hygiene are associated with increased risk of various chronic cardiovascular diseases. Moreover, healthy sleep is essential for cognitive functions and prevention of cognitive decline and memory impairments in the elderly. Relationship between neurodegenerative disorders and poor sleep quality seems to be bidirectional, what is extensively studied in Parkinson’s disease. Regular physical activity should be considered as a component of sleep quality management strategies in the elderly, but also as a preventive strategy to preserve healthy sleep for healthy aging.
References
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55. Sai Y, Zou Z, Peng K, Dong Z. The Parkinson's disease-related genes act in mitochondrial homeostasis, Neuroscience & Biobehavioral Reviews, 2012; 36 (9): 2034-43.
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57. MacMahon Copas AN, McComish SF, Fletcher JM and Caldwell MA (2021) The Pathogenesis of Parkinson's Disease: A Complex Interplay Between Astrocytes, Microglia, and T Lymphocytes? Front. Neurol. 12:666737.
58. Xie, L., Kang, H., Xu, Q., Chen, M. J., Liao, Y., Thiyagarajan, M., et al. (2013). Sleep drives metabolite clearance from the adult brain. Science 342, 373–7.
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63. Atkinson G, Davenne D. Relationships between sleep, physical activity and human health. Physiol Behav. 2007;90(2–3):229–35.
64. Driver HS, Taylor SR. Exercise and sleep. Sleep Med Rev. 2000;4(4):387–402.
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2. Lee J, Kim HJ. Normal Aging Induces Changes in the Brain and Neurodegeneration Progress: Review of the Structural, Biochemical, Metabolic, Cellular, and Molecular Changes. Front Aging Neurosci. 2022;14:931536.
3. Michel JP, Sadana R. "Healthy Aging" Concepts and Measures. J Am Med Dir Assoc. 2017;18(6):460-4.
4. Feinsilver SH. Normal and Abnormal Sleep in the Elderly. Clin Geriatr Med. 2021;37(3):377-86.
5. Besedovsky L, Lange T, Haack M. The Sleep-Immune Crosstalk in Health and Disease. Physiol Rev. 2019;99(3):1325-80.
6. Wunderlin M, Züst MA, Fehér KD, Klöppel S, Nissen C. The role of slow wave sleep in the development of dementia and its potential for preventative interventions. Psychiatry Res Neuroimaging. 2020;306:111178.
7. Dodet, P., Houot, M., Leu-Semenescu, S. et al. Sleep disorders in Parkinson’s disease, an early and multiple problem. npj Parkinsons Dis. 10, 46 (2024).
8. Alnawwar MA, Alraddadi MI, Algethmi RA, Salem GA, Salem MA, Alharbi AA. The Effect of Physical Activity on Sleep Quality and Sleep Disorder: A Systematic Review. Cureus. 2023;15(8):e43595.
9. Zhao H, Lu C, Yi C. Physical Activity and Sleep Quality Association in Different Populations: A Meta-Analysis. Int J Environ Res Public Health. 2023;20(3):1864.
10. Hrnčić D. Sleep, nutrition and physical activity in regulation of brain hyperexcitability: translational aspects. Andrejević Ed, Beograd, 2015.
11. Tatineny P, Shafi F, Gohar A, Bhat A. Sleep in the Elderly. Mo Med. 2020;117(5):490-5.
12. Keenan SA. Normal human sleep. Respir Care Clin N Am. 1999;5(3):319-31,
13. Kumar VM. Physiology of normal sleep: from young to old. Ann Natl Acad Med Sci (India) 2013; 49: 81–89.
14. Miner B, Kryger MH. Sleep in the Aging Population. Sleep Med Clin. 2020;15(2):311-8.
15. Winegar R. Promoting healthy sleep among older adults. Geriatr Nurs. 2024;58:298-303.
16. Cooke JR, Ancoli-Israel S. Normal and abnormal sleep in the elderly. Handb Clin Neurol 2011; 98: 653–65.
17. Ohayon MM, Carskadon MA, Guilleminault C, Vitiello MV. Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: developing normative sleep values across the human lifespan. Sleep. 2004;27(7):1255-73.
18. Mattis J, Sehgal A. Circadian rhythms, sleep, and disorders of aging. Trends Endocrinol Metab 2016; 27: 192–203.
19. Hofman MA, Swab DF. Living by the clock: the circadian pacemaker in older people. Ageing Res Rev 2006; 5: 33–51.
20. Gulia KK, Kumar VM. Sleep disorders in the elderly: a growing challenge. Psychogeriatrics. 2018;18(3):155-65.
21. Besedovsky L, Lange T, Haack M. The Sleep-Immune Crosstalk in Health and Disease. Physiol Rev. 2019;99(3):1325-80.
22. Miller MA, Howarth NE. Sleep and cardiovascular disease. Emerg Top Life Sci. 2023;7(5):457-66.
23. Khan MS, Aouad R. The Effects of Insomnia and Sleep Loss on Cardiovascular Disease. Sleep Med Clin. 2022;17(2):193-203.
24. Grubac Z, Sutulovic N, Ademovic A, Velimirovic M, Rasic-Markovic A, Macut D, Petronijevic N, Stanojlovic O, Hrncic D. Short-term sleep fragmentation enhances anxiety-related behavior: The role of hormonal alterations. PLoS One. 2019;14(7):e0218920.
25. Yeghiazarians Y, Jneid H, Tietjens JR, Redline S, Brown DL, El-Sherif N, Mehra R, Bozkurt B, Ndumele CE, Somers VK. Obstructive Sleep Apnea and Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation. 2021;144(3):e56-e67.
26. Rüger M, Scheer FA. Effects of circadian disruption on the cardiometabolic system. Rev Endocr Metab Disord. 2009;10(4):245-60.
27. Pan Z, Huang M, Huang J, Yao Z, Lin Z. Association of napping and all-cause mortality and incident cardiovascular diseases: a dose-response meta analysis of cohort studies. Sleep Med. 2020; 74:165-72.
28. Wunderlin M, Züst MA, Fehér KD, Klöppel S, Nissen C. The role of slow wave sleep in the development of dementia and its potential for preventative interventions. Psychiatry Res Neuroimaging. 2020;306:111178.
29. Wang C, Holtzman DM. Bidirectional relationship between sleep and Alzheimer's disease: role of amyloid, tau, and other factors. Neuropsychopharmacology. 2020;45(1):104-20.
30. Lucey BP, Hicks TJ, McLeland JS, Toedebusch CD, Boyd J, Elbert DL, et al. Effect of sleep on overnight cerebrospinal fluid amyloid beta kinetics. Ann Neurol. 2018;83:197–204.
31. Tractenberg RE, Singer CM, Kaye JA. Symptoms of sleep disturbance in persons with Alzheimer's disease and normal elderly. J Sleep Res. 2005;14:177–85.
32. Ju YE, McLeland JS, Toedebusch CD, Xiong C, Fagan AM, Duntley SP, et al. Sleep quality and preclinical Alzheimer disease. JAMA Neurol. 2013;70:587–93.
33. Kim RT, Zhou L, Li Y, et al. Impaired sleep is associated with tau deposition on 18F-flortaucipir PET and accelerated cognitive decline, accounting for medications that affect sleep. J Neurol Sci. 2024;458:122927.
34. A. Nadjar, T. Blutstein, A. Aubert, S. Laye, P.G. Haydon. Astrocyte-derived adenosine modulates increased sleep pressure during inflammatory response. Glia. 2013;61:724-31.
35. Choudhury ME, Miyanishi K, Takeda H, et al. Phagocytic elimination of synapses by microglia during sleep. Glia. 2020;68(1):44-59.
36. Grubač Ž, Šutulović N, Šuvakov S, Jerotić D, Puškaš N, Macut D, Rašić-Marković A, Simić T, Stanojlović O, Hrnčić D. Anxiogenic Potential of Experimental Sleep Fragmentation Is Duration-Dependent and Mediated via Oxidative Stress State. Oxid Med Cell Longev. 2021; 2021:2262913.
37. Bubu OM, Andrade AG, Umasabor-Bubu OQ, et al. Obstructive sleep apnea, cognition and Alzheimer's disease: A systematic review integrating three decades of multidisciplinary research. Sleep Med Rev. 2020;50:101250.
38. Schapira, A., Chaudhuri, K. & Jenner, P. Non-motor features of Parkinson disease. Nat Rev Neurosci 18, 435–50 (2017).
39. Oerlemans WG, de Weerd AW. The prevalence of sleep disorders in patients with Parkinson’s disease: A self-reported, community-based survey. Sleep Med. 2002; 3:147–49.
40. Menza M, Dobkin RD, Marin H, Bienfait K. Sleep disturbances in Parkinson's disease. Mov Disord. 2010;25 Suppl 1(Suppl 1): S117-22.
41. Dodet, P., Houot, M., Leu-Semenescu, S. et al. Sleep disorders in Parkinson’s disease, an early and multiple problem. npj Parkinsons Dis. 10, 46 (2024).
42. Di Laudo F, Baldelli L, Mainieri G, Loddo G, Montini A, Pazzaglia C, Sala M, Mignani F and Provini F (2023) Daytime sleepiness in Parkinson's disease: a multifaceted symptom. Front. Sleep 2:1302021
43. Mahmood Z, Van Patten R, Nakhla MZ, Twamley EW, Filoteo JV, Schiehser DM. REM Sleep Behavior Disorder in Parkinson's Disease: Effects on Cognitive, Psychiatric, and Functional outcomes. J Int Neuropsychol Soc. 2020 Oct;26(9):894-905.
44. Ferini-Strambi L, Carli G, Casoni F and Galbiati A (2018) Restless Legs Syndrome and Parkinson Disease: A Causal Relationship Between the Two Disorders? Front. Neurol. 9:551.
45. Hwang SR, Hwang SW, Chen JC, Hwang JH. Association of periodic limb movements during sleep and Parkinson disease: A retrospective clinical study. Medicine (Baltimore). 2019 Dec;98(51): e18444
46. Salsone M and Ferini-Strambi L (2023) Editorial: Sleep disturbances in Parkinson's disease. Front. Neurosci. 17:1133296.
47. Leng Y, Blackwell T, Cawthon PM et al (2020) Association of circadian abnormalities in older adults with an increased risk of developing Parkinson disease. JAMA Neurol 77:1270–8.
48. Duan, X., Liu, H., Hu, X. et al. Insomnia in Parkinson’s Disease: Causes, Consequences, and Therapeutic Approaches. Mol Neurobiol (2024). https://doi.org/10.1007/s12035-024-04400-4
49. Kalaitzakis ME, Gentleman SM, Pearce RKB (2013) Disturbed sleep in Parkinson’s disease: anatomical and pathological correlates. Neuropathol Appl Neurobiol 39:644–53.
50. Giguère N, Burke Nanni S, Trudeau L-E (2018) On cell loss and selective vulnerability of neuronal populations in Parkinson’s disease. Front Neurol 9:455.
51. Calabresi, P., Mechelli, A., Natale, G. et al. Alpha-synuclein in Parkinson’s disease and other synucleinopathies: from overt neurodegeneration back to early synaptic dysfunction. Cell Death Dis 14, 176 (2023).
52. Forloni, G. Alpha Synuclein: Neurodegeneration and Inflammation. Int. J. Mol. Sci. 2023, 24, 5914.
53. Yoo G, Shin YK, Lee NK. The Role of α-Synuclein in SNARE-mediated Synaptic Vesicle Fusion. J Mol Biol 2023; 435 (1): 167775.
54. Segura-Aguilar, J., Paris, I. (2022). Mechanisms of Dopamine Oxidation and Parkinson’s Disease. In: Kostrzewa, R.M. (eds) Handbook of Neurotoxicity. Springer, Cham. pp. 1-30. https://doi.org/10.1007/978-3-030-71519-9_16-1
55. Sai Y, Zou Z, Peng K, Dong Z. The Parkinson's disease-related genes act in mitochondrial homeostasis, Neuroscience & Biobehavioral Reviews, 2012; 36 (9): 2034-43.
56. Jan A, Gonçalves NP, Vaegter CB, Jensen PH, Ferreira N. The Prion-Like Spreading of Alpha-Synuclein in Parkinson's Disease: Update on Models and Hypotheses. Int J Mol Sci. 2021;22(15):8338.
57. MacMahon Copas AN, McComish SF, Fletcher JM and Caldwell MA (2021) The Pathogenesis of Parkinson's Disease: A Complex Interplay Between Astrocytes, Microglia, and T Lymphocytes? Front. Neurol. 12:666737.
58. Xie, L., Kang, H., Xu, Q., Chen, M. J., Liao, Y., Thiyagarajan, M., et al. (2013). Sleep drives metabolite clearance from the adult brain. Science 342, 373–7.
59. Mattis, J., and Sehgal, A. (2016). Circadian rhythms, sleep, and disorders of aging. Trends Endocrinol. Metab. 27, 192–203.
60. Sohail, S., Yu, L., Schneider, J. A., Bennett, D. A., Buchman, A. S., and Lim, A. S. P. (2017). Sleep fragmentation and Parkinson’s disease pathology in older adults without Parkinson’s disease. Mov. Disord. 32, 1729–37.
61. Yang Z, Zhang X, Li C, Chi S, Xie A (2021) Molecular Mechanisms Underlying Reciprocal Interactions Between Sleep Disorders and Parkinson’s Disease. Front. Neurosci. 14:592989.
62. Blondell SJ, Hammersley-Mather R, Veerman JL. Does physical activity prevent cognitive decline and dementia? A systematic review and meta-analysis of longitudinal studies. BMC Public Health. 2014; 14:510.
63. Atkinson G, Davenne D. Relationships between sleep, physical activity and human health. Physiol Behav. 2007;90(2–3):229–35.
64. Driver HS, Taylor SR. Exercise and sleep. Sleep Med Rev. 2000;4(4):387–402.
65. Kubitz KA, Landers DM, Petruzzello SJ, Han M. The effects of acute and chronic exercise on sleep. A meta-analytic review. Sports Med Auckl NZ. 1996;21(4):277–91.
66. Alnawwar MA, Alraddadi MI, Algethmi RA, Salem GA, Salem MA, Alharbi AA. The Effect of Physical Activity on Sleep Quality and Sleep Disorder: A Systematic Review. Cureus. 2023;15(8): e43595.
67. Solis-Navarro L, Masot O, Torres-Castro R, Otto-Yáñez M, Fernández-Jané C, Solà-Madurell M, et al. Effects on Sleep Quality of Physical Exercise Programs in Older Adults: A Systematic Review and Meta-Analysis. Clocks Sleep. 2023;5(2):152.
68. Vanderlinden J, Boen F, Uffelen JGZ van. Effects of physical activity programs on sleep outcomes in older adults: a systematic review. Int J Behav Nutr Phys Act. 2020; 17:11.
69. Reid KJ, Baron KG, Lu B, Naylor E, Wolfe L, Zee PC. Aerobic exercise improves self-reported sleep and quality of life in older adults with insomnia. Sleep Med. 2010;11(9):934–40.
70. Li F, Fisher KJ, Harmer P, Irbe D, Tearse RG, Weimer C. Tai chi and self-rated quality of sleep and daytime sleepiness in older adults: a randomized controlled trial. J Am Geriatr Soc. 2004;52(6):892–900.
71. Hariprasad VR, Sivakumar PT, Koparde V, Varambally S, Thirthalli J, Varghese M, et al. Effects of yoga intervention on sleep and quality-of-life in elderly: A randomized controlled trial. Indian J Psychiatry. 2013;55(Suppl 3): S364.
72. Zettergren KK, Lubeski JM, Viverito JM. Effects of a yoga program on postural control, mobility, and gait speed in community-living older adults: a pilot study. J Geriatr Phys Ther 2001. 2011;34(2):88–94.
73. Wang F, Boros S. The effect of physical activity on sleep quality: a systematic review. Eur J Physiother. 2021;23(1):11–8.